Provider Demographics
NPI:1114298197
Name:LAGO, RACHEL (PHD)
Entity Type:Individual
Prefix:DR
First Name:RACHEL
Middle Name:
Last Name:LAGO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4801 W WHITEHALL RD
Mailing Address - Street 2:
Mailing Address - City:PENNSYLVANIA FURNACE
Mailing Address - State:PA
Mailing Address - Zip Code:16865-9557
Mailing Address - Country:US
Mailing Address - Phone:814-404-1937
Mailing Address - Fax:
Practice Address - Street 1:2180 SCHOOL DR
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16803-1130
Practice Address - Country:US
Practice Address - Phone:814-272-3994
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-23
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool